Treatment Of Heart Block Research Articles

Predicting 1-, 3-, 5-, and 8-year all-cause mortality in a community-dwelling older adult cohort: relevance for predictive, preventive, and personalized medicine

BackgroundPopulation aging is a global public health issue involving increased prevalence of age-related diseases, and concomitant burden on medical resources and the economy. Ninety-two diseases have been identified as age-related, accounting for 51.3% of the global adult disease burden. The economic cost per capita for older people over 60 years is 10 times that of the younger population. From the aspects of predictive, preventive, and personalized medicine (PPPM), developing a risk-prediction model can help identify individuals at high risk for all-cause mortality and provide an opportunity for targeted prevention through personalized intervention at an early stage. However, there is still a lack of predictive models to help community-dwelling older adults do well in healthcare.ObjectivesThis study aims to develop an accurate 1-, 3-, 5-, and 8-year all-cause mortality risk-prediction model by using clinical multidimensional variables, and investigate risk factors for 1-, 3-, 5-, and 8-year all-cause mortality in community-dwelling older adults to guide primary prevention.MethodsThis is a two-center cohort study. Inclusion criteria: (1) community-dwelling adult, (2) resided in the districts of Chaonan or Haojiang for more than 6 months in the past 12 months, and (3) completed a health examination. Exclusion criteria: (1) age less than 60 years, (2) more than 30 incomplete variables, (3) no signed informed consent. The primary outcome of the study was all-cause mortality obtained from face-to-face interviews, telephone interviews, and the medical death database from 2012 to 2021. Finally, we enrolled 5085 community-dwelling adults, 60 years and older, who underwent routine health screening in the Chaonan and Haojiang districts, southern China, from 2012 to 2021. Of them, 3091 participants from Chaonan were recruited as the primary training and internal validation study cohort, while 1994 participants from Haojiang were recruited as the external validation cohort. A total of 95 clinical multidimensional variables, including demographics, lifestyle behaviors, symptoms, medical history, family history, physical examination, laboratory tests, and electrocardiogram (ECG) data were collected to identify candidate risk factors and characteristics. Risk factors were identified using least absolute shrinkage and selection operator (LASSO) models and multivariable Cox proportional hazards regression analysis. A nomogram predictive model for 1-, 3-, 5- and 8-year all-cause mortality was constructed. The accuracy and calibration of the nomogram prediction model were assessed using the concordance index (C-index), integrated Brier score (IBS), receiver operating characteristic (ROC), and calibration curves. The clinical validity of the model was assessed using decision curve analysis (DCA).ResultsNine independent risk factors for 1-, 3-, 5-, and 8-year all-cause mortality were identified, including increased age, male, alcohol status, higher daily liquor consumption, history of cancer, elevated fasting glucose, lower hemoglobin, higher heart rate, and the occurrence of heart block. The acquisition of risk factor criteria is low cost, easily obtained, convenient for clinical application, and provides new insights and targets for the development of personalized prevention and interventions for high-risk individuals. The areas under the curve (AUC) of the nomogram model were 0.767, 0.776, and 0.806, and the C-indexes were 0.765, 0.775, and 0.797, in the training, internal validation, and external validation sets, respectively. The IBS was less than 0.25, which indicates good calibration. Calibration and decision curves showed that the predicted probabilities were in good agreement with the actual probabilities and had good clinical predictive value for PPPM.ConclusionThe personalized risk prediction model can identify individuals at high risk of all-cause mortality, help offer primary care to prevent all-cause mortality, and provide personalized medical treatment for these high-risk individuals from the PPPM perspective. Strict control of daily liquor consumption, lowering fasting glucose, raising hemoglobin, controlling heart rate, and treatment of heart block could be beneficial for improving survival in elderly populations.

Conduction Disturbances and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Predictors and Prevention.

Conduction disturbances and permanent pacemaker implantation (PPMI) remain a frequent and important consequence of transcatheter aortic valve replacement (TAVR). Understanding risk factors for TAVR-related conduction disturbances could improve patient selection, procedural techniques, and periprocedural efforts for monitoring and treatment of heart block. Several studies have identified patient-related and procedural factors associated with new-onset left bundle branch block, high-degree atrioventricular block, and the need for PPMI after TAVR. Notable patient-related predictors include preexisting right bundle branch block, membranous septal length, and calcification of the left ventricular outflow tract. Modifiable procedural predictors include device implantation depth, prosthesis oversizing, and valve type. This review aims to summarize the current literature examining predictors of conduction disturbances and PPMI after TAVR, particularly with regard to the newer-generation valve types. We also propose a management algorithm for the management of conduction disturbances postprocedure.

Cellular Reprogramming Approaches to Engineer Cardiac Pacemakers.

The goal of this paper is to review present knowledge regarding biological pacemakers created by somatic reprogramming as a platform for mechanistic and metabolic understanding of the rare subpopulation of pacemaker cells, with the ultimate goal of creating biological alternatives to electronic pacing devices. Somatic reprogramming of cardiomyocytes by reexpression of embryonic transcription factor T-box 18 (TBX18) converts them into pacemaker-like. Recent studies take advantage of this model to gain insight into the electromechanical, metabolic, and architectural intricacies of the cardiac pacemaker cell across various models, including a surgical model of complete atrioventricular block (CAVB) in adult rats. The studies reviewed here reinforce the potential utility of TBX18-induced pacemaker myocytes (iPMS) as a minimally invasive treatment for heart block. Several challenges which must be overcome to develop a viable therapeutic intervention based on these observations are discussed.

Prospective echocardiographic evaluation of AV conduction in fetuses with maternal SSA/SSB antibodies

TION IN FETUSES WITH MATERNAL SSA/SSB ANTIBODIES ANDREW VAN BERGEN, MARC OVADIA, RONALD WAKAI, BRIAN MCCULLOCH, MARK KALCHBRENNER, BETTINA CUNEO, The Heart Institute for Children, Perinatal Cardiology, Oak Lawn, IL The University of Wisconsin, Medical Physics, Madison, WI Advocate Perinatal Center, Maternal Fetal Medicine, Park Ridge, IL Advocate Perinatal Center, Maternal Fetal Medicine, Oak Lawn, IL OBJECTIVE: While only a small fraction of SSA/SSB-positive pregnancies are complicated by complete heart block (HB), substantial fetal and infant morbidity andmortality, as well as reports of successful treatment of incomplete HB with maternally administered steroids, make early diagnosis of conduction abnormalities desirable. In this study we investigated whether prospective Doppler interrogation of the mechanical PR interval could identify fetuses with incomplete HB who might benefit from in utero treatment. STUDY DESIGN: Maternal histories and fetal echocardiograms performed secondary to maternal SSA/SSB antibodies at two large maternity services between 1997 and 2003 were reviewed. The mechanical PR interval .was measured from onset of mitral A wave to onset of aortic outflow for three beats. The mean ( ± SD) mechanical PR intervals of study patients were compared to fetuses with known autoimmune firstand second-degree HB on fetal magnetocardiography (controls). Differences were determined by MannWhitney test. RESULTS: 128 fetal echocardiograms were performed on 68 women at 23.7 ± 5.1 (range 16-32 weeks) during their 1st (36), 2nd (18), 1st and 2nd (4), or >2nd (10) pregnancies. One previous child had incomplete fetal HB that did not progress after maternally administered dexamethasone. Sixty-four mothers had SSA, and 4 had SSA/SSB antibodies. Mechanical PR intervals ranged from 97-142 (121.3 ± 11.8) msec in the study group and were significantly different from the 4 controls (191.5 ± 22.4msec, P = 000). All study infants were liveborn with no HB or dilated cardiomyopathy. CONCLUSION: Mechanical PR intervals can be successfully measured in fetuses from 16-32 weeks of gestation. The incidence of conduction abnormalities in fetuses with maternal SSA/SSB and a negative family history is extremely low (0/68). The mechanical PR is an effective discriminant and should be evaluated prospectively.

MORTALITY OF HEART BLOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION MANAGED WITHOUT ARTIFICIAL PACEMAKERS

AbstractComplete heart block has been observed in 42 (7%) of 603 patients with acute myocardial infarction (AMI) between 1966 and 1969 in this hospital. In addition 11 patients got their complete heart block after resuscitation and are excluded from this material. Of the 42 patients 24 were given isoprenaline and 10 insulin, glucose and potassium. No patients were treated with artificial pacemaker. Twenty‐two (52.4%) of the patients with complete heart block died, compared to a total mortality of 30%. The most adverse prognostic factors were BP below 80 mmHg (12 patients) and syncope (12 patients). Of the 22 patients with posterior infarction 11 (50%) died, compared to 4 (33.3%) of the 12 patients with anterior infarction. Of the 8 patients with posterior and anterior infarction or uncertain localization of the infarct 7 (87.5%) died. Of the 22 patients who died 13 died of shock or cardiac failure, 4 of ventricular fibrillation, 4 of asystole and 1 of a stroke. More information must be collected to demonstrate unequivocally the value of artificial pacemaker in the treatment of heart block in AMI.

Implantable transvenous cardiac pacemakers: indications, complications and management.

AbstractPermanent transvenous pacing of the heart for control of both rate and rhythm has achieved widespread acceptance in the treatment of heart block. It is now performed in adults of any age group, and there are no special contraindications. Data are presented on the results of 122 transvenous pacemaker implantations from one to three years after operation. The average age of the patients was 68, and 38 of them were over 75 years old. Episodic sinus arrest or asystole in patients with otherwise adequate cardiac rates can be detected by continuous electrocardiographic monitoring and treated by implantation of demand‐type pacemakers. Asynchronous units now are used only in very elderly patients with stable complete heart block.Displacement of the catheter has been the major problem; if recurrent, it is managed by direct epicardial insertion of the pacemaker leads through an extrapleural approach to the heart. The longevity of the power‐pack components and the battery still falls short of the manufacturers' claims. This emphasizes the need for establishment of pacemaker clinics so that sudden failure of pacemakers can be prevented.

Advances in Cardiac Pacemakers.

This is the 560-page report of a Conference on Advances in Cardiac Pacemakers sponsored by the New York Academy of Sciences, Nov 17 to 19, 1968 and published Oct 30, 1969. This monumental work updates their publication of June 1964 on cardiac pacemakers and includes 49 separate presentations and 11 panel discussions by experts from many parts of the world. The following represent the general areas of discussion: (1) indications for cardiac pacing, (2) emergency pacing techniques, (3) energy sources and pacer longevity, (4) threshold of cardiac stimulation, (5) technical and clinical aspects of pacing electrodes, (6) engineering considerations of asynchronous pacing, (7) engineering considerations of triggered pacing, (8) rhythm disturbances and pacing, and (9) clinical results of various pacing techniques. There have been many advances since cardiac pacemakers were introduced 12 years ago. Current indications for their use are no longer limited to the treatment of heart block. Pacemakers

Endocrine disease and anaesthesia. A review of anaesthetic management in pituitary, adrenal and thyroid diseases.

Endocrine disease and anaesthesia. A review of anaesthetic management in pituitary, adrenal and thyroid diseases.

Psychological aspects of pacemaker implantation.

THE implantation of a cardiac pacemaker is a procedure of dramatic importance to the patient, but an operation so commonplace that is is considered routine by the medical staff. Although external electrodes were used in 1952 to pace the heart, 1 it was only in 1957 that the technique of internal implantation in the myocardium was developed. 2 Since it was first undertaken as a treatment for heart block, the techniques of insertion and the devices used have been progressively refined and a considerable literature regarding surgical technique has resulted. Surprisingly, a procedure of such profound psychological impact on the recipient has aroused little psychiatric interest and references to it in the psychiatric literature are few. 3,4 The implanted pacemaker is a small, battery-operated device which rhythmically stimulates the myocardium at a controllable rate. It is used for the treatment of heart block when

Artificial pacemakers in the treatment of heart block: Bay, G. (Norweg.). Tid. Norsk Laegefor. No. 7, 617, 1968. (Rikshospital, Oslo 1, Norway.)

Artificial pacemakers in the treatment of heart block: Bay, G. (Norweg.). Tid. Norsk Laegefor. No. 7, 617, 1968. (Rikshospital, Oslo 1, Norway.)

Treatment of heart block from a clinical viewpoint.

Abstract In a material of 85 patients with total heart block treated with artificial pacemakers a review of the etiology shows that most of the patients suffered from a diffuse myocardial fibrosis. Only in three patients was coronary artery disease present. In this material there are also many patients with aortic valvular disease and four with previous toxic diphtheria. Most of the patients had atrioventricular block. Eight patients had sino‐atrial block.Adams‐Stokes attacks were the predominant indication for cardiac pacing. Only a few patients had pacemaker implantation on account of congestive heart failure or vertigo.Various modes of cardiac pacing have been used. At the present time intracardial pacemaking is the method of choice, and an increasing number of on‐demand pacemakers are now applied. This is of paramount importance in patients with competition between sinus rhythm and pacemaker rhythm. Four such patients were seen in this material. Three died suddenly of cardiac standstill in the immediate postoperative period. One was successfully defibrillated.

Endocardiac Pacemaker-Induced Diaphragmatic Contractions

PERMANENT implantable endocardiac pacemaker systems have greatly extended the surgical treatment of heart-block. Patients judged to be unfit for thoracotomy may now be offered substantial symptomatic relief with a relatively lowrisk operation employing local anesthesia. Early in the clinical experience of permanent endocardiac pacing, one expected electrode dislodgement, intermittent contact of the electrode due to myocardial contraction, rising myocardial impedance to electrode stimulation, predisposition to thrombosis by the large intravascular foreign body electrode, and possibly tricuspid insufficiency. Prior to treating the two patients described in this report, we had encountered only dislodgement and intermittent contact of the bipolar electrode. These complications have been uncommon and have been noted early in the postoperative period. They have been easily remedied by further manipulation through the same incisions, with the patient under local anesthesia. Recently, we have seen two patients who presented with vigorous diaphragmatic contractions noted approximately six weeks and four months

The permanent transvenous electrode-catheter pacemaker for treatment of heart block

The permanent transvenous electrode-catheter pacemaker for treatment of heart block

Treatment of heart block in children.

Treatment of heart block in children.

Clinical evaluation of oral long-active isoprenaline in treatment of heart-block.

Clinical evaluation of oral long-active isoprenaline in treatment of heart-block.

The treatment of heart block in the elderly

Thirty-nine patients over 75 years of age, with symptoms from chronic atrioventricular block, have been treated during a 5-year period. Seventeen patients were maintained on long-acting isoprenaline, and 7 have remained well and active for an average time of 8 months (range 2 months–2 years). Ten patients have died, 7 of them from Stokes-Adams attacks, after an average time of 9 months (range 2 days–3 years). Twenty-two patients were treated by long-term artificial pacing, and 15 have survived, most of them being kept fully active and well for an average time of 16 months. Seven patients have died, 5 from failure or complications of their pacing system, after an average time of 9 months (range 2 days–2.5 years). All elderly patients with symptoms from heart block should be treated initially with large doses of long-acting isoprenaline, and if this fails completely to control symptoms, long-term artificial pacing is recommended. The lower mortality and morbidity of long-term endocardial pacing makes this form of treatment worthwhile in elderly patients even if relatively incapacitated by other, unrelated, diseases.

PACEMAKER-INDUCED VENTRICULAR TACHYCARDIA.

THE MOST COMMON failures of implanted cardiac pacemakers used in the treatment of heart block have been due to wire breakage, electrode detachment, or battery depletion. Electronic malfunction has occurred in 1% or less of implanted units. 1,2 This report documents ventricular tachycardia and ventricular fibrillation caused by electronic failure of an internal electrical pacemaker. Report of a Case A 64-year-old man had a fixed-rate pacemaker implanted in 1961 for treatment of complete heart block. Two years later, Oct 3, 1963, the battery unit required replacement because of battery depletion. On June 1, 1964, augmentation of the pacemaker output was necessary, due to increased resistance of one electrode. Testing of the battery unit revealed a normal output and rate with no evidence of a direct-current leak. Two weeks later, on June 14, the patient had the onset of intermittent syncopal episodes. Physical examination revealed a pale, anxious man. The blood

PACEMAKER THERAPY IN HEART BLOCK AND STOKES-ADAMS SYNDROME.

The introduction of the implantable cardiac pacemaker has revolutionized the clinical management of heart block in the past three years. 1 Prior to this period, the treatment of the acute phase of Stokes-Adams syndrome and its long-term management was based on temporary artificial pacing of the heart and the use of drugs to improve atrioventricular (A-V) conduction and stimulate idioventricular pacemaker centers. At present, surgical implantation of an artificial pacemaker has become the standard procedure for the treatment of heart block. It therefore behooves the clinician to know the present indications for pacemaker implantation, the optimal time for surgery, the preoperative preparation, and the problems arising following pacemaker implantation. Recent experience has indicated that our present equipment, although superior to the original units introduced three years ago, is far from foolproof and that frequent mechanical and electrical breakdowns occur. This applies not only to the electrode wires, but also to

RADIOFREQUENCY STIMULATION: A RESEARCH AND CLINICAL TOOL.

The radio frequency induction technique is now an important tool in physiological experiments and in the treatment of certain diseases. It has come to play an important role in the treatment of heart block in human patients, where medication has been ineffective. In the case of bladder stimulation, work with animals has shown that the voiding of urine can be induced by electrical stimulation. The successful use of this technique on human patients has yet to be consistently achieved, but there is reason to be optimistic.

Treatment of Heart Block

Treatment of Heart Block